Survey: Vulvar and Vaginal Atrophy “Under-recognized”

Vulvar and vaginal atrophy (VVA) affects up to two-thirds of postmenopausal women, but many of them are unaware that it is a medical condition, according to a recent survey.

Estrogen is an important hormone for vulvar and vaginal health. But when estrogen levels drop at menopause, cellular changes in these areas occur. As a result, women may have trouble with vaginal lubrication. The vagina may become shorter, narrower, and less elastic, making intercourse uncomfortable or painful. Itching and irritation are common symptoms as well.

There are a variety of treatments available for women with VVA, including prescription hormone therapy. However, many women do not use this therapy. (Moisturizers, lubricants, and the drug Osphena are other options.)

The EMPOWER survey was conducted so that researchers could learn more about women’s knowledge and perceptions of VVA and its treatment options. Researchers also asked questions about women’s interactions with their doctors and their feelings about existing therapies.

The 63-item survey was completed by 1,858 women between the ages of 45 and 90 who lived in the United States and had VVA symptoms. Their average age was 58.

Eighty-one percent did not know that VVA was a medical condition and 56% had never talked to their doctor about their symptoms. Many thought their symptoms were just a part of the aging process that they needed to accept. (In fact, 20% said that their doctor gave them this information.) Others felt too embarrassed to discuss their symptoms with a doctor.

Among those who did talk to their doctor, 85% said that they brought up their subject themselves. Fourteen percent reported that their doctor started the discussion.

VVA had an effect on the women’s sex lives, with 13% saying they would like to have more sex, but VVA symptoms made it difficult. Almost a third said they were satisfied with the amount of sex they had, but would enjoy it more if VVA symptoms could be resolved.

Many of the women had reservations about hormonal therapies; safety and side effects were among the top concerns. Of those who used vaginal estrogen therapy, less than half followed the prescribed dosing regimen and only one-third to one-half felt that the treatment was effective. About three quarters of the women used non-hormonal therapies. Overall, however, no one product had a satisfaction rate of 70%, considered the “benchmark for acceptable patient satisfaction.”

VVA is a “under-recognized and under-treated condition,” the study authors wrote, adding that many women would “welcome the discussion” about VVA symptoms if their healthcare provider broached the subject.

“An unmet need remains for a VVA treatment that is easy to use and has an acceptable safety and efficacy profile that would facilitate interaction between [healthcare providers] and patients,” they wrote.

The survey results were published online last month in the Journal of Sexual Medicine. The survey was commissioned by TherapeuticsMD, a pharmaceutical company that develops women’s health products.